Less Than Half of U.S. Jails Offer Medications to Treat Opioid Use Disorder, According to a New JCOIN Study

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Recent findings from a nationally representative survey found that only 44% of U.S. jails provide medications to treat opioid use disorder (OUD) and only 13% offered at least one medication to anyone with OUD who requested it. The survey of 1,028 jails was conducted between June 2022 and April 2023 by JCOIN researchers. MOUD has proven effective in reducing opioid use and overdoses, decreasing overdose deaths, and increasing the use of community-based treatment among individuals involved in the criminal-legal system. However, many jails indicate a significant lack of the resources and programs needed to provide adequate access to these services, such as staffing, policies, funding, and local community-based service providers. 

 

Among jails that did offer MOUD, buprenorphine was the most common, with 70% of facilities providing the medication. However, only 28% of these jails made buprenorphine available to all individuals with an OUD, while the majority reserved it for specific groups, such as pregnant women (40%) or those already receiving buprenorphine prior to incarceration (72%). Methadone was less frequently available, with just 47% of MOUD-providing jails offering it, and access was often limited to those already on methadone treatment at the time of booking. Naltrexone was available in 55% of jails that offered MOUD, with broader access compared to buprenorphine or methadone, as 37% of these facilities provided it to anyone with OUD who requested it. 

 

Almost three-fourths of jails (70%) provided some type of SUD treatment or recovery support. The most common support was self-help meetings (e.g., Alcoholics Anonymous or SMART Recovery), which were available in 63% of jails. Other types of programs offered by jails included services for co-occurring mental health conditions (48%), therapeutic communities within the correctional system (35%), and outpatient SUD treatment (33%). 

 

The survey identified multiple factors influencing whether jails offer MOUD, including staffing models, regional differences, community context, and jail size. Among jails that did not provide MOUD but offered other types of SUD treatment, about 50% cited a lack of sufficient licensed staff as a significant barrier. Jails without direct or contracted healthcare services were less likely to offer MOUD, underscoring the importance of having an adequate healthcare infrastructure to support these programs. Availability also varied by region, with jails in the Northeast being 15 times more likely to provide treatment to anyone who requests it and nearly ten times for MOUD than in the South. Jails in the Midwest and West also showed slightly higher rates of treatment access than in Southern states.

 

Community factors such as social vulnerability (e.g., poverty, unemployment, and housing instability) and proximity to community-based MOUD providers impacted treatment availability in jails, with more vulnerable or remote areas being less likely to offer MOUD. Larger jails with populations over 200 residents are more likely to provide MOUD, likely due to greater access to resources, while smaller jails face more challenges, potentially due to limited infrastructure.

 

The latest data reveal significant gaps in the availability of evidence-based MOUD within U.S. jails, with geographic, staffing, and community-based factors all contributing to the disparity. As jails continue to grapple with the substantial number of individuals with OUD, ensuring that these facilities offer comprehensive and accessible treatments is a critical step in addressing the broader SUD and overdose crisis. Enhancing MOUD availability in jails can reduce opioid-related deaths and improve health outcomes for some of the most vulnerable populations, ultimately benefiting public health and safety on a national scale.

 

The study was conducted between June 2022 and April 2023 and led by Elizabeth Flanagan Balawajder, Dr. Bruce Taylor, Phoebe Lamuda from NORC at the University of Chicago, Dr. Harold Pollack, Dr. John Schneider from the University of Chicago, Dr. Lori Ducharme from the National Institute on Drug Abuse, Dr. Marynia Kolak from the University of Illinois at Urbana-Champaign, and Dr. Peter Friedmann from the Baystate Health and University of Massachusetts Chan Medical School-Baystate. Findings were published in JAMA Open Network.

Key Takeaways:

  • Fewer than half (44%) of jails surveyed offer MOUD, and only 13% provide at least one medication to anyone who requests it.
  • Among jails providing MOUD, buprenorphine was the most commonly available (70%), followed by naltrexone (55%) and methadone (47%). However, access is often restricted based on criteria like pregnancy or prior treatment status.
  • Staffing shortages and inadequate healthcare infrastructure are significant barriers. Jails with no on-site health care services were less likely to offer MOUD, and about half of jails cited insufficient licensed staff as a limitation to providing MOUD.
  • MOUD availability varies by region, with jails in the Northeast far more likely to provide these treatments than those in the South.
  • Jails in areas with high social vulnerability (e.g., poverty, unemployment, and housing instability) or far from community-based MOUD providers were less likely to offer treatment. Larger jails were more likely to provide MOUD than smaller, resource-limited facilities.

 

This summary is based on the findings from the following publication:

Flanagan Balawajder, E., Ducharme, L., Taylor, B. G., Lamuda, P. A., Kolak, M., Friedmann, P. D., Pollack, H. A., & Schneider, J. A. (2024). Factors associated with the availability of medications for opioid use disorder in US jails. JAMA Network Open, 7(9), e2434704. https://doi.org/10.1001/jamanetworkopen.2024.34704